Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial

doi:10.1007/s00134-018-5088-x

Randomized Controlled Trial

. 2018 Mar;44(3):300-310.

doi: 10.1007/s00134-018-5088-x. Epub 2018 Feb 26.

Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial

Philippe Montravers^{1

2}, Florence Tubach³, Thomas Lescot⁴, Benoit Veber⁵, Marina Esposito-Farèse⁶, Philippe Seguin⁷, Catherine Paugam⁸, Alain Lepape⁹, Claude Meistelman¹⁰, Joel Cousson¹¹, Antoine Tesniere¹², Gaetan Plantefeve¹³, Gilles Blasco¹⁴, Karim Asehnoune¹⁵, Samir Jaber¹⁶, Sigismond Lasocki¹⁷, Herve Dupont¹⁸; DURAPOP Trial Group

Collaborators, Affiliations

Collaborators

DURAPOP Trial Group:
Philippe Montravers, Regis Bronchard, Mathieu Desmard, Herve Dupont, Melanie Levrard, Yazine Mahjoub, Sigismond Lasocki, Soizic Gergaud, Thomas Gaillard, Gaetan Plantefeve, Olivier Pajot, Gilles Blasco, Emmanuel Samain, Guillaume Besch, Sebastien Pily-Floury, Catherine Paugam, Sebastien Pease, Paer Abback, Claude Girard, Jean-Francois Payen, Marie-Christine Herault, Samir Jaber, Boris Jung, Jean-Marc Delay, Josette Gally, Claude Meistelman, Jean-François Perrier, Karim Asehnoune, Raphael Cinotti, Antoine Tesniere, Alexandre Mignon, Thomas Lescot, Nouria Belhadj-Tahar, Marc Beaussier, Alain Lepape, Vincent Piriou, Florent Wallet, Candice Tassin, Joel Cousson, Pascal Raclot, Thierry Floch, Philippe Seguin, Yoann Launey, Benoit Veber, Philippe Gouin, Thomas Clavier, Christian Auboyer, Olivier Collanges, Jean-François Georger

Affiliations

¹ Anaesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, INSERM, UMR 1152, Paris Diderot Sorbonne Cite University, Paris, France. philippe.montravers@aphp.fr.
² Département d'Anesthésie-Réanimation, CHU Bichat Claude Bernard, 48 rue Henri Huchard, 75018, Paris, France. philippe.montravers@aphp.fr.
³ Département de Biostatistique, Santé Publique et Information Médicale (BIOSPIM), Hôpital Pitié-Salpêtrière, AP-HP, INSERM, UMR 1123, ECEVE, CIC-EC 1425, Sorbonne Universités, UPMC Univ Paris 06, 75013, Paris, France.
⁴ Department of Anaesthesiology and Critical Care Medicine, St Antoine Hospital, APHP, Sorbonne Universites, UPMC Univ Paris 06, Paris, France.
⁵ Pole Anesthésie-Réanimation-SAMU, Rouen University Hospital, Rouen, France.
⁶ INSERM CIC-EC 1425, Unité de Recherche Clinique, HUPNVS, CHU Bichat-Claude Bernard, APHP, Paris, France.
⁷ Department of Anaesthesiology and Surgical Intensive Care Medicine, CHU Rennes, Rennes, France.
⁸ Department of Anaesthesiology and Surgical Intensive Care Medicine, CHU Beaujon, Clichy, Paris Diderot Sorbonne Cite University, Paris, France.
⁹ Intensive Care Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
¹⁰ Service d'Anesthésie Réanimation, CHU Brabois, Nancy, France.
¹¹ Pôle Anesthésie-Réanimation, CHU Reims, Reims, France.
¹² Surgical Intensive Care Unit, CHU Cochin, Paris Descartes University, Paris, France.
¹³ Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France.
¹⁴ Service d'Anesthésie Réanimation Chirurgicale, CHU Besancon, Besançon, France.
¹⁵ Service d'Anesthésie et Réanimation Chirurgicale, Hotel Dieu, CHU Nantes, Nantes, France.
¹⁶ Service d'Anesthésie Réanimation, Hopital St Eloi, CHU Montpellier, Montpellier, France.
¹⁷ Département d'Anesthésie Réanimation, CHU Angers, L'UBL, Université d'Angers, Angers, France.
¹⁸ Critical Care Medicine Department, Amiens University Hospital, INSERM U1088, University of Picardy Jules Verne, Amiens, France.

PMID: 29484469
DOI: 10.1007/s00134-018-5088-x

Free article

Randomized Controlled Trial

Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial

Philippe Montravers et al. Intensive Care Med. 2018 Mar.

Free article

. 2018 Mar;44(3):300-310.

doi: 10.1007/s00134-018-5088-x. Epub 2018 Feb 26.

Authors

Collaborators

DURAPOP Trial Group:
Philippe Montravers, Regis Bronchard, Mathieu Desmard, Herve Dupont, Melanie Levrard, Yazine Mahjoub, Sigismond Lasocki, Soizic Gergaud, Thomas Gaillard, Gaetan Plantefeve, Olivier Pajot, Gilles Blasco, Emmanuel Samain, Guillaume Besch, Sebastien Pily-Floury, Catherine Paugam, Sebastien Pease, Paer Abback, Claude Girard, Jean-Francois Payen, Marie-Christine Herault, Samir Jaber, Boris Jung, Jean-Marc Delay, Josette Gally, Claude Meistelman, Jean-François Perrier, Karim Asehnoune, Raphael Cinotti, Antoine Tesniere, Alexandre Mignon, Thomas Lescot, Nouria Belhadj-Tahar, Marc Beaussier, Alain Lepape, Vincent Piriou, Florent Wallet, Candice Tassin, Joel Cousson, Pascal Raclot, Thierry Floch, Philippe Seguin, Yoann Launey, Benoit Veber, Philippe Gouin, Thomas Clavier, Christian Auboyer, Olivier Collanges, Jean-François Georger

Affiliations

¹ Anaesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, HUPNSV, AP-HP, INSERM, UMR 1152, Paris Diderot Sorbonne Cite University, Paris, France. philippe.montravers@aphp.fr.
² Département d'Anesthésie-Réanimation, CHU Bichat Claude Bernard, 48 rue Henri Huchard, 75018, Paris, France. philippe.montravers@aphp.fr.
³ Département de Biostatistique, Santé Publique et Information Médicale (BIOSPIM), Hôpital Pitié-Salpêtrière, AP-HP, INSERM, UMR 1123, ECEVE, CIC-EC 1425, Sorbonne Universités, UPMC Univ Paris 06, 75013, Paris, France.
⁴ Department of Anaesthesiology and Critical Care Medicine, St Antoine Hospital, APHP, Sorbonne Universites, UPMC Univ Paris 06, Paris, France.
⁵ Pole Anesthésie-Réanimation-SAMU, Rouen University Hospital, Rouen, France.
⁶ INSERM CIC-EC 1425, Unité de Recherche Clinique, HUPNVS, CHU Bichat-Claude Bernard, APHP, Paris, France.
⁷ Department of Anaesthesiology and Surgical Intensive Care Medicine, CHU Rennes, Rennes, France.
⁸ Department of Anaesthesiology and Surgical Intensive Care Medicine, CHU Beaujon, Clichy, Paris Diderot Sorbonne Cite University, Paris, France.
⁹ Intensive Care Unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
¹⁰ Service d'Anesthésie Réanimation, CHU Brabois, Nancy, France.
¹¹ Pôle Anesthésie-Réanimation, CHU Reims, Reims, France.
¹² Surgical Intensive Care Unit, CHU Cochin, Paris Descartes University, Paris, France.
¹³ Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France.
¹⁴ Service d'Anesthésie Réanimation Chirurgicale, CHU Besancon, Besançon, France.
¹⁵ Service d'Anesthésie et Réanimation Chirurgicale, Hotel Dieu, CHU Nantes, Nantes, France.
¹⁶ Service d'Anesthésie Réanimation, Hopital St Eloi, CHU Montpellier, Montpellier, France.
¹⁷ Département d'Anesthésie Réanimation, CHU Angers, L'UBL, Université d'Angers, Angers, France.
¹⁸ Critical Care Medicine Department, Amiens University Hospital, INSERM U1088, University of Picardy Jules Verne, Amiens, France.

PMID: 29484469
DOI: 10.1007/s00134-018-5088-x

Abstract

Purpose: Shortening the duration of antibiotic therapy (ABT) is a key measure in antimicrobial stewardship. The optimal duration of ABT for treatment of postoperative intra-abdominal infections (PIAI) in critically ill patients is unknown.

Methods: A multicentre prospective randomised trial conducted in 21 French intensive care units (ICU) between May 2011 and February 2015 compared the efficacy and safety of 8-day versus 15-day antibiotic therapy in critically ill patients with PIAI. Among 410 eligible patients (adequate source control and ABT on day 0), 249 patients were randomly assigned on day 8 to either stop ABT immediately (n = 126) or to continue ABT until day 15 (n = 123). The primary endpoint was the number of antibiotic-free days between randomisation (day 8) and day 28. Secondary outcomes were death, ICU and hospital length of stay, emergence of multidrug-resistant (MDR) bacteria and reoperation rate, with 45-day follow-up.

Results: Patients treated for 8 days had a higher median number of antibiotic-free days than those treated for 15 days (15 [6-20] vs 12 [6-13] days, respectively; P < 0.0001) (Wilcoxon rank difference 4.99 days [95% CI 2.99-6.00; P < 0.0001). Equivalence was established in terms of 45-day mortality (rate difference 0.038, 95% CI - 0.013 to 0.061). Treatments did not differ in terms of ICU and hospital length of stay, emergence of MDR bacteria or reoperation rate, while subsequent drainages between day 8 and day 45 were observed following short-course ABT (P = 0.041).

Conclusion: Short-course antibiotic therapy in critically ill ICU patients with PIAI reduces antibiotic exposure. Continuation of treatment until day 15 is not associated with any clinical benefit. CLINICALTRIALS.

Gov identifier: NCT01311765.

Keywords: Antibiotic therapy; Duration of therapy; Multidrug-resistant bacteria; Peritonitis; Postoperative intra-abdominal infection.

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Comment in

Is very short-course antibiotic therapy possible in postoperative intra-abdominal infections? Discussion on "Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial".
Suarez-de-la-Rica A, Gilsanz F, Maseda E, Montravers P, Lasocki S, Lescot T, Dupont H. Suarez-de-la-Rica A, et al. Intensive Care Med. 2018 May;44(5):695-696. doi: 10.1007/s00134-018-5167-z. Epub 2018 Apr 13. Intensive Care Med. 2018. PMID: 29654347 No abstract available.
Impact of combined antibiotic treatment on multidrug-resistant bacteria emergence after postoperative intra-abdominal infections : Discussion on the DURAPOP randomised clinical trial.
Simeone P, Lagier D, Mokart D, Montravers P, Esposito-Farèse M, Lasocki S, Dupont H. Simeone P, et al. Intensive Care Med. 2018 Jun;44(6):1000-1001. doi: 10.1007/s00134-018-5215-8. Epub 2018 May 12. Intensive Care Med. 2018. PMID: 29754311 No abstract available.
More evidence for shortening antibiotic therapy in peritonitis: the DURAPOP trial.
Abidi HH, Sawyer RG. Abidi HH, et al. J Thorac Dis. 2018 Sep;10(Suppl 26):S3160-S3161. doi: 10.21037/jtd.2018.07.67. J Thorac Dis. 2018. PMID: 30370104 Free PMC article. No abstract available.
Antibiotic duration can be shortened in postoperative intra-abdominal infection.
Kim IK, Lee JG. Kim IK, et al. J Thorac Dis. 2018 Sep;10(Suppl 26):S3182-S3183. doi: 10.21037/jtd.2018.07.93. J Thorac Dis. 2018. PMID: 30370107 Free PMC article. No abstract available.

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References

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[1] J Antimicrob Chemother. 2011 Oct;66(10):2379-85 - PubMed

[2] J Antimicrob Chemother. 2011 Oct;66(10):2379-85 - PubMed

[3] Clin Infect Dis. 2016 May 15;62(10 ):e51-77 - PubMed

[4] Clin Infect Dis. 2016 May 15;62(10 ):e51-77 - PubMed

[5] Clin Infect Dis. 2010 Jan 15;50(2):133-64 - PubMed

[6] Clin Infect Dis. 2010 Jan 15;50(2):133-64 - PubMed

[7] Surg Infect (Larchmt). 2013 Jun;14(3):297-303 - PubMed

[8] Surg Infect (Larchmt). 2013 Jun;14(3):297-303 - PubMed

[9] BMC Infect Dis. 2014 Jul 29;14:420 - PubMed

[10] BMC Infect Dis. 2014 Jul 29;14:420 - PubMed

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Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial

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Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial

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